Glenn F
Ann Surg. 1981 Jan;193(1):56-9. doi: 10.1097/00000658-198101000-00009.
The proportion of the population of the U.S. 65 years of age and over is increasing. Biliary tract disease is estimated to involve 15% of the adult population. A review of 12,200 patients treated surgically at one medical center reveals that 2401 (20%) had acute cholecystitis. There were 93 deaths, for a mortality rate of 3.8%. Sixty-five of the 93 deaths, for a mortality rate of 3.8%. Sixty-five of the 93 deaths occurred in 665 patients 65 years of age and older, for a mortality rate of 9.8%. These elderly patients accounted for 69.9% of the deaths from acute cholecystitis. It is suggested that acute cholecystitis in patients 65 years of age and older may be prevented by a more aggressive surgical approach to cholelithiasis when those patients are younger. Indeed, the present improved methods of diagnosis and an awareness of gallstones by the public is resulting in many more patients seeking medical advice in the early years of the disease. On the basis of a review of an experience in the surgical treatment of acute cholecystitis two proposals are made concerning the management of patients 65 years of age and over. First, the operation should be performed with minimal delay following diagnosis, and such specific correction of physiologic impairment should be performed as is feasible. Second, the procedure to be performed on the elderly patient should be one that alleviates the present problem, and accomplished by imposing the minimal burden upon the patient.
美国65岁及以上人口的比例正在增加。据估计，胆道疾病累及15%的成年人口。对某一医疗中心接受手术治疗的12200名患者进行的回顾显示，2401例（20%）患有急性胆囊炎。有93例死亡，死亡率为3.8%。93例死亡中的65例，死亡率为3.8%。93例死亡中的65例发生在665名65岁及以上的患者中，死亡率为9.8%。这些老年患者占急性胆囊炎死亡人数的69.9%。有人提出，对于65岁及以上的患者，如果在其年轻时对胆石症采取更积极的手术方法，可能预防急性胆囊炎。事实上，目前诊断方法的改进以及公众对胆结石的认识，使得更多患者在疾病早期就寻求医疗建议。基于对急性胆囊炎手术治疗经验的回顾，针对65岁及以上患者的治疗提出了两项建议。第一，诊断后应尽快进行手术，并应尽可能对生理损伤进行具体纠正。第二，对老年患者进行的手术应是能够缓解当前问题的手术，并应将对患者的负担降至最低。
